Incident Response Guide: Active Shooter Mission To protect patients, staff, and visitors during an active shooter incident. Directions Read this entire response guide and review the Hospital Incident Management Team Activation chart. Use this response guide as a checklist to ensure all tasks are addressed and completed. Objectives Ensure the safety of patients, staff, and visitors Notify law enforcement, staff, patients, and visitors of the threat Contain the scene and minimize the number of potential victims Coordinate the hospital response with the law enforcement incident command system Return to normal operations as quickly as possible Incident Response Guide Active Shooter Page 1
Immediate Response (0 10 minutes) Section Officer Time Action Initials Ensure notification of all staff, patients, and visitors of the threat using mass notification, overhead page, radios, and phones, as appropriate. Notify law enforcement and provide details of the event. Notify the hospital Chief Executive Officer, Board of s, and other appropriate internal and external officials of situation status. Incident Commander Activate the Emergency Operations Plan and Active Shooter Plan. Activate the Hospital Command Center and the applicable Hospital Incident Management Team positions. Ensure the location of the Hospital Command Center (and the routes to and from it) is in an offsite location or in a secured area away from any danger posed by the shooter. Command Establish a Liaison with law enforcement upon their arrival. Establish operational periods, objectives, and a regular briefing schedule. Consider the use of the Incident Action Plan Quick Start for initial documentation of the incident. Public Information Officer Liaison Officer Safety Officer Monitor media outlets for updates on the incident and possible impacts on the hospital. Communicate information via regular briefings to s and Incident Commander as directed. Notify community partners in accordance with local policies and procedures (e.g., consider local Emergency Operations Center, other area hospitals, local emergency medical services, and healthcare coalition coordinator), to determine incident details, community status, estimates of casualties, and establish contacts for requesting supplies, equipment, or personnel not available in the hospital. Ensure the safety of patients, families, visitors, and staff during evacuation procedures. Incident Response Guide Active Shooter Page 2
Immediate Response (0 minutes 10 minutes) Section Branch/Unit Time Action Initials Refer to the Job Action Sheet for appropriate tasks. Ensure all staff have basic information about current location of shooter, designated escape routes, and safe zones. Medical Care Branch Place the emergency department on diversion. Initiate the shelter-in-place of all patients who are non-ambulatory. Assist in the evacuation of other personnel as directed. Initiate external lockdown of the hospital as approved by the Incident Commander: Operations Deny all entry; direct those seeking medical care to nearest hospital Deny all exits; direct those trying to leave the hospital to a designated safe holding area Coordinate movement within the campus with law enforcement and Incident Commander Security Branch Consider activation of a Law Enforcement Interface Unit to coordinate activities and information with responding law enforcement. Establish communications with responding law enforcement. Provide law enforcement with the shooter s description, armament, and last known location. Provide law enforcement with surveillance camera footage, hospital maps, blueprints, master keys, card access, search grids, and other data as requested. As directed, utilize access control system and closed circuit cameras to aid the law enforcement assault teams and internal responses (shelter-in-place or evacuations) relative to the shooter s location. Incident Response Guide Active Shooter Page 3
Assist with the safe evacuation of patients, staff, and visitors as directed. Coordinate the overall response to ensure effective communications to and from potential victims within the hospital relative to the shooter s location, and shelter-in-place or evacuation response actions as directed. Planning Situation Unit Refer to the Job Action Sheet for appropriate tasks. Consolidate all reports regarding the location and description of the shooter. Ensure the real time dissemination of this critical information to all parties as directed. Intermediate Response (10 minutes 2 hours) Section Officer Time Action Initials Incident Commander Suspend all nonessential services. Inform agency executives, Board of s, corporate headquarters and others as appropriate, of ongoing operations and incident status. Command Public Information Officer Liaison Officer Safety Officer Designate and establish a media staging area in coordination with law enforcement and the Incident Commander. Establish contact with media and inform them of the media staging area; provide briefings as directed. Provide approved messages to media, patients, visitors, and staff as directed. Notify the Department of Health Services and licensing agencies of the incident. Ensure continued updates of appropriate information to community partners, local authorities, and others as directed. Complete HICS 215A to assign, direct, and ensure safety actions are adhered to and completed. Incident Response Guide Active Shooter Page 4
Intermediate Response (10 minutes 2 hours) Section Branch/Unit Time Action Initials Refer to the Job Action Sheet for appropriate tasks. Operations Planning Logistics Medical Care Branch Infrastructure Branch Security Branch Resources Unit Situation Unit Support Branch Continue to coordinate the evacuation of patients and personnel as directed and as needed. Treat and evacuate wounded victims as directed and when deemed safe to do so. Monitor critical systems such as medical gases, water, electricity and others as appropriate for potential disruption caused by stray gunfire penetrations. As directed, utilize the access control system and closed circuit television to aid law enforcement in the clearing of the hospital. Maintain the external lockdown of the hospital. Establish operational periods, incident objectives and the Incident Action Plan in collaboration with the Incident Commander. Begin planning for alternate care sites for evacuated patient care areas that may not be immediately available. Initiate staff and equipment tracking. Document victim information, witness information, and patient movement. Continue to provide situation reports to all parties as requested and as needed. Initiate patient and bed tracking using HICS 254. Refer to the Job Action Sheet for appropriate tasks. Coordinate the transportation services (ambulance, air medical services, and other transportation) with the Operations Section (Medical Care Branch) and appropriate external Incident Command Post or jurisdictional authority to ensure safe patient relocation, if necessary. Incident Response Guide Active Shooter Page 5
Finance/ Administration Time Unit Refer to the Job Action Sheet for appropriate tasks. Track hours associated with the emergency response. Extended Response (2 hours - 8 hours) Section Officer Time Action Initials Incident Commander With the Public Information Officer, prepare to speak with the media, stakeholders, staff, patients, and visitors as coordinated with the field-level Incident Command Post or jurisdictional authority. Command Public Information Officer Liaison Officer Safety Officer Continue media briefings and updates as directed; work within the Joint Information Center, if available. Continue to provide approved messaging to media, patients, visitors, and staff. Ensure continued updates of appropriate information to community partners, local authorities, and others as directed. Update the Safety Plan for extended operations based on modifications in entry and exit points, visiting hours, entry onto campus, etc. Extended Response (2 hours - 8 hours) Section Branch/Unit Time Action Initials Determine the need to cancel or postpone procedures, appointments, and visiting hours based on the projected length and impact of the incident. Operations Medical Care Branch Security Branch Where approved, return evacuated patients to their respective patient care areas. Arrange for the transfer of patients from displaced patient care areas to approved alternate care sites. Modify the external lockdown of the hospital, as directed, to maintain the integrity of the crime scene, yet allow limited access. Incident Response Guide Active Shooter Page 6
Planning Logistics Patient Family Assistance Branch Situation Unit Documentation Unit Support Branch Ensure the debriefing of, and support for, families of affected patients. Plan for the next operational period and hospital shift change, if any; hospital and campus entry and exit relative to lockdown; impact on canceled procedures and appointments, etc. Work with law enforcement to ensure continued security of hospital and ongoing operations. Ensure that updated information and intelligence is incorporated into the Incident Action Plan. Ensure a Demobilization Plan is being readied. Continue tracking the movement and disposition of patients, staff, and visitors. Continue documenting the victim, witness, and patient information. Ensure complete documentation of all postponed and canceled appointments and procedures. Coordinate victim support services and establish those services in a safe zone as approved by the Incident Commander. Demobilization/System Recovery (8 hours 24 hours) Section Officer Time Action Initials Incident Commander With the Public Information Officer and Joint Information System, prepare to speak with media. Ensure patients, staff, and visitors have access to behavioral health services. Command Public Information Officer Liaison Officer Develop an information release for media; work with law enforcement on details to be released; ensure the family of any wounded or deceased person is made aware prior to the media release of information. Ensure that all impacted persons and community partners are notified of incident resolution in accordance with local policies and procedures. Incident Response Guide Active Shooter Page 7
Safety Officer Provide incident documentation to the Documentation Unit. Demobilization/System Recovery (8 hours 24 hours) Section Branch/Unit Time Action Initials Oversee the restoration of normal operations. Operations Planning Medical Care Branch Infrastructure Branch Security Branch Patient Family Assistance Branch Situation Unit Reschedule canceled surgeries, procedures, and outpatient appointments. Repatriate transferred patients, if applicable. Arrange for the transfer of patients from alternate care sites back to reopened patient care areas. Repair or replace any systems damaged by stray gunfire penetrations. Demobilize the hospital lockdown as directed. Plan for the safe and confidential reunification of incident victims with family members. Conduct debriefings and hotwash with: Command Staff and section personnel Administrative personnel All staff All volunteers First responders Write an After Action Report and Corrective Action and Improvement Plan for submission to the Incident Commander, including: Summary of the incident Summary of actions taken Actions that went well Actions that could be improved Recommendations for future response actions Provide incident documentation to the Documentation Unit. Incident Response Guide Active Shooter Page 8
Logistics Finance/ Administration Documentation Unit Demobilization Unit Support Branch Compensation / Claims Unit Ensure that all documentation produced during the response and recovery is correlated and available for after action review. Prepare a summary of the status and location of all incident patients, staff, and equipment. After approval by the Incident Commander, distribute it to appropriate external agencies. Identify issues and necessary actions to return to normal operations, ensuring all cancellations and postponements are included. Complete the Demobilization Plan and distribute it as per policy. Inventory all Hospital Command Center and hospital supplies and replenish them as necessary, appropriate, and available. Ensure the debriefing of affected personnel. Plan for the safe and confidential reunification of staff victims with family members. Ensure behavioral health services are made available to staff. Compile final response and recovery costs and expenditure summary and submit to the Incident Commander. Provide a summary of incident s projected costs due to modification in operations. Incident Response Guide Active Shooter Page 9
Documents and Tools Emergency Operations Plan, including: Active Shooter Plan Shelter-in-Place Plan Evacuation Plan Lockdown Plan Employee Health monitoring and treatment Plan Patient, staff, and equipment tracking procedures Business Continuity Plan Behavioral Health Support Plan Alternate Care Site Plan Security Plan Fatality Management Plan Emergency Patient Registration Plan Risk Communication Plan Interoperable Communications Plan Demobilization Plan Forms, including: HICS Incident Action Plan (IAP) Quick Start HICS 200 Incident Action Plan (IAP) Cover Sheet HICS 201 Incident Briefing HICS 202 Incident Objectives HICS 203 Organization Assignment List HICS 205A Communications List HICS 214 Activity Log HICS 215A Incident Action Plan (IAP) Safety Analysis HICS 221 Demobilization Checklist HICS 251 Facility System Status Report HICS 253 Volunteer Registration HICS 254 Disaster Victim/Patient Tracking HICS 255 Master Patient Evacuation Tracking Job Action Sheets Security Access Control System Security Closed Circuit Television (CCTV) System Hospital and campus floor plans, maps, and blueprints Telephone/cell phone/satellite phone/internet/amateur radio/2-way radio for communication Incident Response Guide Active Shooter Page 10
Hospital Incident Management Team Activation: Active Shooter Position Immediate Intermediate Extended Recovery Incident Commander X X X X Public Information Officer X X X X Liaison Officer X X X X Safety Officer X X X X Operations X X X X Medical Care Branch X X X X Infrastructure Branch X X X Security Branch X X X X Patient Family Assistance Branch Dir. X X Planning X X X X Resources Unit X X X Situation Unit X X X X Documentation Unit X X Demobilization Unit X Logistics X X X Support Branch X X X Finance /Administration X X X Time Unit X X X Compensation/Claims Unit X Incident Response Guide Active Shooter Page 11